Monitoring

During prednisolone taper, patients should be evaluated for toxicity and relapse with periodic clinical evaluation supported by inflammatory markers. Relapses should be diagnosed objectively as at diagnosis. Isolated elevation of inflammatory markers in the absence of clinical symptoms should not automatically result in escalation of therapy. Imaging is not routinely recommended for follow-up in patients in clinical and biochemical remission.[38] Ultrasound, fluorodeoxyglucose-positron emission tomography, or magnetic resonance imaging may be used for assessing vessel abnormalities in patients with large vessel vasculitis with suspected relapse, particularly when laboratory markers of inflammation are unreliable.[38] Magnetic resonance angiography, computed tomography angiography, or ultrasound may be used for long-term monitoring of structural damage, particularly at sites of preceding vascular inflammation.[38] However, ultrasonography in follow-up is not yet adequately defined. Some patients have persistent changes in the larger arteries but these do not necessarily imply treatment failure or predict relapses.[105] The frequency of screening as well as the imaging method applied should be decided on an individual basis.[38]

Patients on long-term glucocorticoids can develop glucocorticoid-induced adverse effects.[37] Patients should be monitored for diabetes, elevated blood pressure, and glucocorticoid-induced bone loss.[66][67][68] Patients sometimes have a normochromic, normocytic anaemia with a normal white blood cell count and elevated platelet count. Full blood count should be monitored.

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